The Junkie in the O.R. - Article

[MmacFN]

The Junkie in the O.R.(Some doctors are addicted to the very drugs they prescribe. Find out why going under the knife could be more dangerous than you think)

link;
http://www.menshealth.com/cda/articl...0012281eac____ (http://www.menshealth.com/cda/article.do?site=MensHealth&channel=health&category=doctors.hospitals&conitem=d7a4dfaa4d41e010VgnVCM20000012281eac____)

Cole called attorney Richard Silver and was soon plunged into a dark side of medical care that he'd never dreamed existed. Silver began digging and learned that Sadie's anesthesiologist -- Dr. Jay Angeluzzi -- had behaved bizarrely during the procedure. First, he'd failed to recognize that Sadie had stopped breathing, even after the electronic monitor's alarms sounded. Then, instead of examining her, he'd turned off the alarms and left the room. It would be 9 critical minutes before anyone noticed Sadie was not responsive. By the time she was revived, her brain had been oxygen starved and ruined.

So why not just have docs step up to the cup, same as pilots and pro cyclists? One big problem: There's no test for fentanyl, the drug of choice for most addicted anesthesia providers. "We had Abbott Laboratories working on a fentanyl test for more than a year," says Dr. Arens, who had commissioned the project on behalf of the American Society of Anesthesiologists. "But they failed. Every variation showed false positives with antihistamines. So it's easy to call for randomized drug tests, but what do you do if you have no test?"

Writhing agony on the operating table is what finally trapped Dr. Frank Ruhl Peterson, a 45-year-old Pennsylvania anesthesiologist who was sentenced to 10 to 23 months in prison in 1997. "He had more than 200 patients in the couple of months he was there. When I asked him how many of his patients he shortchanged on the drugs, he said, 'Everybody,' " the investigating detective told the Associated Press. "Since the patients were under no anesthetic, they could actually feel the scalpel cutting them, and the operations had to be stopped."

Wait, he thought. What if the drugs are escaping from the patients' breath? The system for delivering drugs may be airtight, but how about the ventilation? Dr. Gold enlisted the University of Florida's nanotechnology group to use its mass spectronomy equipment to test for the presence of drugs above a patient's mouth. They scanned an O.R., and . . . jackpot! Sure enough, narcotics were detected not only in the air, but also on metal trays and tables -- exactly the way vaporized gas would settle. "Fentanyl is extremely potent and active in the air -- that's why the Russians used it to put everyone in the theater to sleep during the Chechen hostage crisis," Dr. Gold explains. "It's also easily absorbed through the skin."


Dr. Gold became aware of how many anesthesiologists were diverting drugs into their own veins while he was assessing 20 years' worth of confidential records at the Physicians Recovery Network, an intervention and rehabilitation organization. He was struck by how often "anesthesiology" turned up as an addicted doctor's specialty, so he began tabulating. Dr. Gold has been an addiction expert for more than 30 years, but even that didn't prepare him for the total: Anesthesiologists are overrepresented by a staggering 500 percent.

"I lost 12 top residents to addiction in 12 years, and I don't know how many others I've missed," concedes James Arens, M.D., chairman of the anesthesiology department at the University of Texas Health Science Center at Houston. "I never confronted a resident who didn't have narcotic addiction, which tells me I didn't confront enough." Translation: If he'd been wrong a few times, Dr. Arens would be more confident he was erring on the side of caution.

[TranMan]

I recall a lecture in school with statistics ranging b/t 30-35% of anesthesia providers and pharmacists. At the time, I was really suprised by those numbers. My 1st year out, I was hired to replace a CRNA who had OD at work, and another new grad was later let go for stealing Fentanyl. :nurse:

[trp100329]

Holy cow - that's scary. How can you sleep at night if you're diverting meds away from someone who really needs them?

Personally, every time I have ever had narcotics, I've experienced the most godawful vertigo - I can't imagine inducing that on purpose. Logically, you know the room isn't spinning but it feels just like being on one of those kid's carousel toys on the playground. All I can do is lay there and be sick. So far I haven't found a pain that's bad enough to make me want to deal with the vertigo, and luckily, toradol works really well for me for pain control.

Wonder if I'll have a problem with fentanyl-contaminated surfaces in the OR? Of course, as layered up as I have to be to be comfortable in the cold hospital environment, I'll probably be protected. I've never had issues with the fentanyl gtt's in the unit, so it probably won't be an issue in the OR, either.

Thanks, Mike, for sharing such an interesting article.

Terri


The Junkie in the O.R.(Some doctors are addicted to the very drugs they prescribe. Find out why going under the knife could be more dangerous than you think)

link;
http://www.menshealth.com/cda/articl...0012281eac____ (http://www.menshealth.com/cda/article.do?site=MensHealth&channel=health&category=doctors.hospitals&conitem=d7a4dfaa4d41e010VgnVCM20000012281eac____)

Cole called attorney Richard Silver and was soon plunged into a dark side of medical care that he'd never dreamed existed. Silver began digging and learned that Sadie's anesthesiologist -- Dr. Jay Angeluzzi -- had behaved bizarrely during the procedure. First, he'd failed to recognize that Sadie had stopped breathing, even after the electronic monitor's alarms sounded. Then, instead of examining her, he'd turned off the alarms and left the room. It would be 9 critical minutes before anyone noticed Sadie was not responsive. By the time she was revived, her brain had been oxygen starved and ruined.

So why not just have docs step up to the cup, same as pilots and pro cyclists? One big problem: There's no test for fentanyl, the drug of choice for most addicted anesthesia providers. "We had Abbott Laboratories working on a fentanyl test for more than a year," says Dr. Arens, who had commissioned the project on behalf of the American Society of Anesthesiologists. "But they failed. Every variation showed false positives with antihistamines. So it's easy to call for randomized drug tests, but what do you do if you have no test?"

Writhing agony on the operating table is what finally trapped Dr. Frank Ruhl Peterson, a 45-year-old Pennsylvania anesthesiologist who was sentenced to 10 to 23 months in prison in 1997. "He had more than 200 patients in the couple of months he was there. When I asked him how many of his patients he shortchanged on the drugs, he said, 'Everybody,' " the investigating detective told the Associated Press. "Since the patients were under no anesthetic, they could actually feel the scalpel cutting them, and the operations had to be stopped."

Wait, he thought. What if the drugs are escaping from the patients' breath? The system for delivering drugs may be airtight, but how about the ventilation? Dr. Gold enlisted the University of Florida's nanotechnology group to use its mass spectronomy equipment to test for the presence of drugs above a patient's mouth. They scanned an O.R., and . . . jackpot! Sure enough, narcotics were detected not only in the air, but also on metal trays and tables -- exactly the way vaporized gas would settle. "Fentanyl is extremely potent and active in the air -- that's why the Russians used it to put everyone in the theater to sleep during the Chechen hostage crisis," Dr. Gold explains. "It's also easily absorbed through the skin."


Dr. Gold became aware of how many anesthesiologists were diverting drugs into their own veins while he was assessing 20 years' worth of confidential records at the Physicians Recovery Network, an intervention and rehabilitation organization. He was struck by how often "anesthesiology" turned up as an addicted doctor's specialty, so he began tabulating. Dr. Gold has been an addiction expert for more than 30 years, but even that didn't prepare him for the total: Anesthesiologists are overrepresented by a staggering 500 percent.

"I lost 12 top residents to addiction in 12 years, and I don't know how many others I've missed," concedes James Arens, M.D., chairman of the anesthesiology department at the University of Texas Health Science Center at Houston. "I never confronted a resident who didn't have narcotic addiction, which tells me I didn't confront enough." Translation: If he'd been wrong a few times, Dr. Arens would be more confident he was erring on the side of caution.

[dianecrna]

This is not an informative article for the public's health but a sensationalized topic used to sell magazines. Dr. Mark Lema (ASA president), as well as myself, have sent a letter to the editors of Men's Health to point out the low journalistic standards employed by the author. I would like to add that outright libel has also occurred.

I am very knowledgeable of the facts of Dr. Angeluzzi's health and malpractice cases. I should be - I am his caretaker, wife and a CRNA. We have never been contacted to respond to any of the horrid allegations that have appeared for the past 6 years in the media. But none of them have been as blatantly libelous as this article.

My husband was hospitalized for depression once before the Cole case - because in the 80's all the antidepressants were triggers for his asthma and the valium (prescribed by his psychiatrist, as was the usual case in the 80's) he was prescribed for depression was not helping. He asked someone to cover his call at St. Raphael's and submitted to inpatient treatment of situational depression (he was getting divorced) without ever putting a patient at risk. When he later applied for a license in Massachusetts and voluntarily mentioned his hospitalization, the board had no idea how to deal with this so they used the same forms used for doctors on probation, much to the dismay of my husband's psychiatrist. He wasn't on probation per the board but being monitored by his own doctor for signs of depression. Obviously, the doctors on the licensing board of Massachusetts had never had another doctor admit to treatment of depression before and went way overboard on this one. Unfortunately, someone in their office also made the mistake of giving this confidential information to attorney Silver (who refused to return it at the request of Massachusetts), which then set in motion his groundless allegations of substance abuse. He even quoted the television show "ER" to strengthen his claims.

What followed next was biased media coverage of Cole and Silver's allegations. Cole reported my husband to the Connecticut State Board of Health with claims of malpractice and substance abuse. (This is an underhanded way of trying the case before it goes to trial - our lawyer had never seen anyone do it before. These complaints are made after a case settles, not before). The allegations were reported by the media but not the board's findings. The board found no indication of substance abuse and determined that Sadie Cole had suffered a CO2 embolus with Dr. Angeluzzi never deviating from standard of care. This did not stop Cole and Silver from continuing to destroy my husband's reputation in the media. Settling the case was the only option once attorney Silver (then president of the CT Trial Lawyers Assoc) managed to taint every potential juror, Dr. Angeluzzi's own expert witnesses, his liability carrier and even the other partners in his group.

By a most horrid coincidence, my husband had another tragic outcome at the same hospital. This time was different as it appears he failed to follow standard of care. We won't ever know what event led to a routine spinal anesthetic for C-section to result in such a bad outcome because the case settled and my husband can't tell you what happened - he was diagnosed with Early Onset Alzheimer's Disease in the months after the incident and is now permanently disabled.

What I've printed is the truth. It's more complicated and less sensational than the lurid allegations I've read too many times before, but it's the truth. And any CRNA, SRNA or MD who reads it should be worried because it could happen to any one of us.

Attorney Silver was exceptionally aggressive, certainly unethical, but within the law with the tactics he used to settle his cases (yes, he was the lawyer for the second case and the media coverage was even worse). He used a past medical treatment (depression) and a miscount of narcotics (many practitioners have had this happen) to make sensationalized allegations in order to settle a case for a large sum. Malpractice lawyers in CT typically receive 40% of the settlement. He had control of the media because he already had a relationship with the media. He used the state board of health to get an idea of how a trial might turn out. He used his own client as a pawn, encouraging his false belief in my husband's actions. And finally, he ruined my husband's reputation.
Silver told our attorney this was "nothing personal against Dr. Angeluzzi," just business. And now he doesn't need to quote "ER" in his motions because he has Men's Health and numerous newspaper articles.

Thank you for letting me tell the truth of my husband's cases. It is interesting to note that msn.com reprinted the Men's Health article but edited out all mention of my husband. It would seem that msn can differentiate between allegations and facts.

As an aside, if any of you have questions or concerns about malpractice allegations or disability insurance feel free to contact me by pm. I know more about both of them than I ever intended. I can't offer legal advice, just personal advice. And I can tell you that you will need someone to talk to if you ever experience malpractice allegations or a disability.

[gobucks1013]

Thank you for letting me tell the truth of my husband's cases.


Diane,

It sounds like an absolute nightmare. Thanks for sharing your husband's side of the story. Hopefully, most educated people understand that there is ususally much more to any story than what the media portrays and no one should rush to judgement based on that information.

My thoughts and prayers are with both you and your husband as well as the families of the 2 patients who suffered tragic outcomes.

On a slightly different note, welcome to this forum. You will be an invaluable resource for all of us. Thank you for offering your help.

[Mumbatex]

:dito: Diane thank you very much for sharing. I am a first year student and still have a long way to go but I can say one of my biggest fears in life is to become the target of an overzealous prosecuter or civil attorney. I wish you, your husband, and family the best.

[MmacFN]

That was amazing

I cant say how appreciative we all our to have someone set the truth straight.

Amazing the lies that are told.

again Thank You

[dianecrna]

Thank you for all of your supportive responses. This forum is the first (but not last) public reply we have ever given in which I have been allowed to tell the truth of my husband's story. I should have known I would get support from fellow CRNA's and SRNA's.

By telling our story, I do not wish to take this thread off-topic from the very real tragedy of substance abuse in the O.R. I think sensationalized articles such as the above will make it much more difficult for us to deal with addiction amongst our colleagues in the future. Knowing how false rumors and allegations destroy reputations, I can only imagine that someone struggling with actual addiction might find themselves quite alone in this profession.